John W. Sharp on eHealth and Health IT

Posts Tagged ‘Medical Informatics’

Full title is, “Chronic Kidney Disease in an Electronic Health Record Problem List: Quality of Care, ESRD, and Mortality” published in the American Journal of Nephrology. It has implications for CKD but other chronic conditions as well regarding the appropriate use of problem lists in the EMR. With CKD, diabetes and other chronic conditions which can be initially diagnosed with a lab test (eGFR for CKD), early identification is possible. But if the patient is not formally given the diagnosis in the problem list, it may lead the lack of early preventive care which can slow the progression of a chronic illness.

On another note, I am also actively blogging for HIMSS and posting blogs from HIMSS volunteers. Check out the HIMSS blog.

It’s been another year of achievement and learning. It would have been difficult a year ago to predict how my professional life would change.

My first trip mixed pleasure and work. Being in Salt Lake City, I agreed to speak to the Utah Center for Clinical and Translational Science on some of my work at the Cleveland Clinic and the Cleveland Clinical and Translational Science Consortium. Bernie LaSalle made the event into a series of presentations by the University of Utah Bioinformatics team which was very informative.

In May and June, I taught my first online course for the Health Informatics program at Kent State University in Clinical Analytics. Earlier in the year I designed the course and had an experienced group of students who were eager to learn this emerging area of informatics.

Since joining HIMSS, I have traveled to the Arlington office and to the mHealth Summit in DC. Great meeting on Mobile Health from the the Venture Summit, to the Danish Health Minister to Esther Dyson and other thought leaders on topics like disruption, global health and business models.

Chapter on Social Media Hubs for a new book on Social Media in Healthcare published by HIMSS (to be available at the HIMSS conference in February)

What will 2014 bring? Certainly opportunities to enhance national collaboration on consumer health issues especially at the HIMSS14 conference where I will be managing the Connected Patient Learning Gallery. In many ways, patient engagement and the connected patient are no longer concepts but are at the tipping point of real change. Things will look very different a year from now and I plan to play a part in it.

My recent Perspective on iHealthbeat focused on the uses of data mining of EMR data which are yet to be fully exploited. My thoughts were provoked by a New York Times article titled, Mining Electronic Records for Revealing Health Data. Although data mining in healthcare has gotten a bad reputation, an approach which respects privacy and a focus on research discovery can yield important results. The potential uses of EMRs in research is another opportunity yet to be realized.

A new article in The Atlantic, The Robot Will See You Now, discusses IBM Watson and other initiatives moving medicine toward what I call Algorithm Medicine and Artificial Intelligence. The potential of mining EMRs to generate real-time clinical decision support has exciting possibilities. However, there are skeptics, especially when the predictions expand to entertain the idea of replacing physicians. Realizing the limitations of technology must be acknowledge. For instance, the concerning problem of copy-and-paste in EMRs would have a negative affect on data mining those records. Also, data mining has presents real challenges both in defining research questions and finding the correct data to answer those questions.

So data mining shows promise but a realistic approach without wild predictions can lead to real discovery and impact on practice.

2012 may go down as a most traveled year for me both in terms of the number of trips and miles traveled but also in terms of new opportunities.

In January, I gave a lecture to the 3rd year medical students at the Cleveland Clinic Lerner College of Medicine on Biomedical Informatics challenging them to think about the future of algorithms in medicine among other topics.

Then in April, it was on to the Netherlands for TEDx Maastricht and a visit to Radboud University Medical Center in Nijmeg en to meet at the ReShape & Innovation Center see a preview of the movie The Waiting Room. Also had a tour of the In Vitro programming there with ePatient Dave. Later in April I attend the Epic Research Advisory Council for the first time. Another valuable meeting of other user of the Epic EMR on the secondary use of EMR data in research and how to integrate research into the EMR.

Epic Campus near Madison, Wisconsin

May brought the publication of a blog post in iHealthbeat on A Look at Social Media in Health Care — Two Years Later , a follow up post on my original commentary on Healthcare social media from 2010. Also, I attended the Patient Experience Summit at the Cleveland Clinic which included fellow HealthWorksCollective bloggers Robin Carrey and Barbara Ficarra. Also published was a Technology Brief from the American Association of Medical Colleges on Mobile Apps. These one page summaries are targeted at medical school leadership.

In July I presented virtually at Salud 2.0 in Bilbao, another offering from Spain in medical innovation. My presentation on Social Media in Health Care: A Reasoned Approach was well received. I had the opportunity to answer questions via phone. Hopefully, I will be able to attend this conference in person in a future year.

In August, I was invited to become Adjunct Faculty at Kent State University in Health Informatics. Preparing a course in Clinical Analytics to be taught in May and June, 2013. This is a completely online masters program will be a new experience for me including online videos, readings, assignments and weekly discussion topics. At the end of August I attend the Ohio Health Data Symposium at Case Western Reserve University. Ohio like many states has a rich repository of public health information on everything from chronic diseases to behavioral health.

In early September, I completed a chapter on Computing and Information for a new textbook on Wireless Health: Remaking of Medicine by Pervasive Technologies. The concept of pervasive technology in healthcare is certainly at a tipping point. The book will be out in February 2013. Also in September I attended an internal Cleveland Clinic event, the annual Healthcare Technology Forum which showcased some of the many IT initiatives at all Cleveland Clinic locations including Abu Dhabi.

November took me to Chicago for the AMIA Annual Symposium. With record attendance (3500), I had the opportunity to organize and present a pre-symposium workshop on Clinical Research Informatics Infrastructure and a poster on the use of a wiki to educate healthcare professionals about secondary use of EMR data. The same week I attend the Informatics Key Functional Committee of the Clinical and Translational Science Awards of the NIH. It was valuable to see what tools are being developed and particularly to attend the Integrated Data Repository workgroup. Also significant for AMIA this year was being featured on the website under Faces of AMIA and participating in the mentorship program, working with an up an coming informaticist, Anja Timmerman. I would encourage all experienced health IT professionals to participate in mentoring to bring along the next generation of informatics.

Quite a year of opportunities and evolution in my thinking. As you can see, much of my work is shifting from social media in healthcare (although this is still an interest of mine) to research informatics and specifically secondary use of EMR data. More later on what next year might bring.

Clinical Integrated Data Repositories are now become common at academic medical centers. With tools like i2b2 and RemedyMD, plus a broad range of analytic tools, access to large volumes of clinical data for research and population management is coming to maturity. The opportunities for use of this data in enabling clinical trials and accelerating research are promising. Quality and patient safety can also be enhanced through use of electronic medical records; a recent New England Journal of Medicine article by Dean Sittig details how to “Use EHRs to Monitor and Improve Patient Safety.” “Organizations must leverage EHRs to facilitate rapid detection of common errors (including EHR-related errors), to monitor the occurrence of high-priority safety events, and to more reliably track trends over time.”

To maximize these opportunities, physicians and other health professionals must develop skills in understanding and utilizing this data. Medical informatics has been successful in developing tools for data mining, but translating raw data into research questions and disease trends requires training medical professionals in new ways of thinking. Understanding clinical workflow in an EMR does not directly translate into this type of research. One must understand how the data is organized and coded to create disease cohorts for analysis. Informaticists are key in training a new generation of physicians in this skill. Because of the complexity of this clinical data, there are three approaches to this data mining and analysis:

Self-service data mining enabled by cohort definition tools, both vendor developed and open source

Analyst provided data – skilled data analysts can pull relevant data sets based on their understanding of the research question and the data. However, there are limitations on the number of experienced data analyst any organization can afford to meet the coming demand

Predictive analytics – this is the realm of the biostatistician who will be key consumers of large data sets to create predictive models to be used in clinical practice. This is also a limited resource, so prioritizing predictive modeling projects which major impact is key

Data mining and analytics should be taught in medical schools for the next generation of providers. Data visualization will be helpful in exploring this complex, big data. More on this in a future post.

I am pleased to be officially Adjunct Faculty for the Kent State University Health Informatics Masters and Certificate program. This unique online program is under the school of Information Architecture and Knowledge Management, meaning it has close ties with both library science and nursing. I will be teaching Clinical Analytics in the May-June 2013 time frame and until then designing the course.

The program description states, “This integrated discipline features specialty domains in management science, management engineering principles, health care delivery and public health, patient safety, information science and computer technology.”
The program is completely online which will be a new challenge for me but is certainly becoming common for health and medical informatics programs appealing to those already in the field. The course fits well with my recent experiences of book chapters in Health Informatics and Wireless Health, the latter of which I developed video lectures. Also, my upcoming presentation at AMIA on Clinical Research Informatics Infrastructure.

And since clinical analytics is my daily focus in clinical research informatics, I am looking forward to condensing my knowledge into this course. Convergence within one’s career is not common – I am fortunate to have these opportunities come together.

Informatics 2.0 is the title of an editorial in the Journal of the American Medical Informatics Association (JAMIA). Subtitled, “implications of social media, mobile health, and patient-reported outcomes for healthcare and individual privacy”, this article reviews some of the recent work published in the journal including social media and mHealth. But what really is Informatics 2.0. We already have multiple definitions of medicine 2.0 and health 2.0. Is this an indication that Medical Informatics is broadening their horizons? Precise definitions are hard to find, but one should inlcude:

consumer health informatics as evidenced by social media in health care

While it may not be as exciting as landing on Mars, there are several conferences this Fall worth noting:

Medicine 2.0 Boston with over 300 presenters and a wide range of topics from mobile and social media to education and personal monitoring devices from every continent. I attended last year at Stanford but will not this year. Will miss the colleagues I have met over the years. Good to see ePatient Dave doing a followup on “Give Me My Damn Data”

Health 2.0 San Francisco – the ultimate showcase for health startups will including preconference workshops on Patients 2.0,Health Law 2.0, Employers 2.0 and Doctorrs 2.0. Would like to see Clinical Trials 2.0 some year as well.

StrataRx conference by O’Reilly on health data. Looks like an excellent line up of speakers and topics although light on providers and EMR vendors.

AMIA 2012 Symposium in Chicago - Mayor Rahm Emanuel Declares October 30 to November 7, 2012 Informatics Week in Chicago. I will be attending and speaking at a preconfence workshop on Clinical Research Informatics Infrastructure.

I am sure there are many more, this is just a highlight of the Fall schedule.

Having written a chapter on eResearch for a book on Health Informatics, I decided to make a video which will be used by the editor, Bob Hoyt, in an eBook edition to come out soon. Both the video and the chapter emphasize the progress that has been made in informatics tools to support every phase of clinical research.